2022 Hypertension Update- NICE Guidance

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Practical GP

Күн бұрын

Пікірлер: 36

@abusaiftakecare618 Ай бұрын

Excellent covering of the subject❤

@practicalgp Ай бұрын

Thank you for your comment and support. I really appreciate it. This was the 2022 video. There’s a 2024 update which covers the same information but in a more concise format. Check it out! kzbin.info/www/bejne/rZusk6qvbriXd7Msi=qpISBYuCo4H7gY7D 🙏

@abusaiftakecare618 Ай бұрын

@practicalgp thanks again, Dr

@practicalgp Ай бұрын

@@abusaiftakecare618 I am pleased that you have found it useful. Thank you for letting me know. It means a lot 🙏

@abusaiftakecare618 Ай бұрын

😊

@practicalgp Ай бұрын

😃🙏

@ojushealthcare5402 2 жыл бұрын

Hi Dr Fernando, great video. Thanks very much! Would it be possible to cover a few other major chronic conditions please? CKD, asthma etc? Thanks again!

@practicalgp 2 жыл бұрын

Thank you for your feedback. Precisely Asthma was going to be my next major topic so stay tuned! 👍Hopefully it will not take too long

@yangtse55 Жыл бұрын

200 - plus !! This puts my GPs' overdiagnosing in perspective - trying to call a handful of whitecoat readings "hypertension" ... the QRISk calculator will doubtless get me soon even with perfect lipids and BMI - AGE is the one variable I can't change... I already lie about my postcode. If the doctor who diagnosed me on the phone actually knew me in real life they would stop wasting resources...

@practicalgp Жыл бұрын

Thank you for your comment. You’re right, QRISK is unforgiving and all men above a certain age will be high risk no matter what. But it’s for each person to decide if they want a medical intervention or not 👍

@ajayiabiodun1456 Жыл бұрын

Grear video, for Afrocarribean first line is calcium channel blocker except if they are diabetic, then ARB/ACEI becomes the first line. For Caucasians less than age 55, ACEI/ARB is first line and age 55 or above Calcium channel blocker. Any dibstic hypertensive ACEI/ARB becomes first option. I am not sure if you mentioned ACEI /ARB as first line for Afrocarribean. Please clarify thanks

@practicalgp Жыл бұрын

Thank you for your comment. I think that your summary is correct although I am not sure what exactly is your query. Diabetes of any ethnicity and any age is ACEI/ARB first, then CCB. The only difference with Affro-Caribbeans is that you’d go in preference for ARB instead of ACEI. But you’ll do that in every occasion, even if you use them after a CCB because ARBs are more effective than ACEIs in Affro-Caribbeans (as a result of their low renin status). This short video may also help, although it’s a very compressed version and 1 minute is not enough time for nuances kzbin.infoBnbcUPriJ9g?si=7xUQZe_wflvT3c6h

@ajayiabiodun1456 Жыл бұрын

@@practicalgp I think from the video you said first line for Afrocarribean is ACEI/ARB, though you later read the guidance and corrected it. You can listen to the video again so you can edit it if possible. I am sure it's likely a mistake.

@practicalgp Жыл бұрын

@@ajayiabiodun1456 ⁠⁠⁠⁠ Could you please tell me where in the video the error is? Are you referring to the slide on minute 19:04? I am sorry if the explanation was not clear there. When I say that you should choose an ARB in preference to an ACEI for Afro-Caribbean patients, I did not mean that it is the step 1 drug of choice, only that, when you face the option between those two, ARBs are more effective for them than ACEIs. The following slide on minute 20:13 talks about the step 1 drugs and it is correct. I am sorry for the confusion

@ajayiabiodun1456 Жыл бұрын

@@practicalgpok I think that's clear now. Thanks

@practicalgp Жыл бұрын

@@ajayiabiodun1456 I am pleased. Thank you for letting me know. Perhaps my choice of words on that slide was not the best. That video is over a year old and I think I should do an updated one on the subject, perhaps a little more concise and to the point. Thank you for your feedback! 👍

@bitcoindoctor 2 жыл бұрын

Is it now 180/120 - this is opposed to 180/100 in the old guidelines ?

@practicalgp 2 жыл бұрын

Not sure which section you are referring to but the summary seems to be this: -If blood pressure measured in the clinic is 180/120 mmHg or higher, we will identify who and how to refer for further investigation and management . -If clinic blood pressure is between 140/90 mmHg and 180/120 mmHg, we will offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. -We will offer antihypertensive drug treatment in addition to lifestyle advice to adults of any age with persistent stage 2 hypertension (which is a clinic blood pressure of 160/100 mmHg or higher. Is that any clearer?

@practicalgp 2 жыл бұрын

In practice, we will investigate and treat someone with a BP of 180/120 more or less straightaway whereas for someone with a BP of, say, 179/119, we will refer for ABPM first. I imagine that the threshold may have been increased thanks to the greater availability of ABPM nowadays.

@bitcoindoctor 2 жыл бұрын

Thank you

@aruns.g.2799 2 жыл бұрын

Hello Dr Fernando, this is a great video with lot of information. I am curious about why magnesium /potassium supplement is not advised when there is evidence that these minerals do help in reduction of hypertension. Magnesium deficiency is known to improve diabetes as well.

@practicalgp 2 жыл бұрын

Hi Arun. Thanks for the comment. I suspect that the answer lies in the way that NICE assesses the evidence. If you look at their “rationale for recommendations” they often say things like “the committee agreed that the study was not adequate to assess the effectiveness of these therapies or to make a recommendation”. So, even if there is evidence, if it’s not strong enough or, even if it’s strong, if it is not cost-effective, they will not recommend it.

@practicalgp 2 жыл бұрын

The only role of potassium is as potassium chloride to reduce salt / sodium chloride consumption. But not advisable for “older people, people with diabetes, pregnant women, people with kidney disease and people taking some antihypertensive drugs, such as ACE inhibitors and angiotensin II receptor blockers” because of the risk of hyperkalaemia.

@aruns.g.2799 2 жыл бұрын

@@practicalgp Thank you! Seems very plausible that this is indeed the reason although one wishes they spell out the whys along with the whats. There are always patients able & willing to spend more on a supplement than a medicine simply to minimize side effects. That choice could be left on individuals. Anyhow if there is any channel that NICE has to take feedback, maybe someone like you could provide such feedback in the hope that future recommendations are more insightful & not merely prescriptive.

@aruns.g.2799 2 жыл бұрын

@@practicalgp Well yes, but then it also needs a dietary recommendation on whether or not foods like potatoes, bananas, spinach etc rich in Potassium may be restricted or not. Of course with periodic blood tests, these mineral imbalances should be caught and corrected.

@practicalgp 2 жыл бұрын

@@aruns.g.2799 Very true. But NICE do not get involved with every aspect of clinical care. Although they give additional guidance, they tend to focus more on technology appraisal.